« ForrigeFortsæt »
our power to explain. On what do these cyclical characters depend? and how can we explain a morbid process marked by periods of activity at one time, and latency and dormancy at another? Virchow has attempted to fathom the cause by supposin that each separate diseased tissue is the source whence the infecting elements are derived, their gradual absorption and accumulation in the blood.”
The Berlin correspondent of the Western Jour. of Medicine gives the following resumé of a lecture by Virchow, on the constitutional changes in syphilis: “Hitherto, we are informed, the outward manifestations of the disease have been the only ones receiving attention. We now know that there exists a whole series of symptoms affecting the internal organs, characteristic of the disease. The brain suffers a softening; the root of the tongue loses its glandular characteristics, smooths off to a polished surface from atrophy of its glands; a chronic pharyngitis, the l'esult of the increase of parenchymal connective tissues; the tonsils is likewise attacked and becomes almost obliterated ; the heart assumes an hypertrophy; the pleuræ present cicatrices on their surfaces, from the contraction and retraction of chronic pleuritis; the liver reduces in size and presents the same cicatrices, in the cases before us, extending completely through the right lobe at its outer third, forming a new lobe; the kidney suffers atrophy, becomes exceedingly pale and granulated on its external surface—the surface of section remains smooth; the atrophy is likewise induced by an increase of the connective tissue, an indurative interstitial nephritis."— Dental Cosmos.
Treatment of Delirium Tremens.
W. McRea, chief officer of Victoria (Med. Times and Gazette), records eight hundred and ninety-eight cases of delirium tremens which occurred in the Melbourne gaol during the past eleven years. In 1864 he began to think that the causes of this affection had been inisunderstood, and that congestion and inflammation of the membranes of the brain were the true cause of this discase. Acting on this idea, he began to use leeches in the aggravated cases, applying twelve under each ear: the effect was striking and beneficial. For the last three years this practice has been pursued. An emetic is first given ; after it has ceased to operate, a cold affusion is applied to the head, and, if the einetic has not acted on the bowels-which it often does—a brisk purgatire
of sulphate of magnesia is given. The patient is then put to bed in a quiet room, under the care of night nurses, who supply him with drink-tea or cold water--and keep a succession of wet cloths to his head during the night. In the morning, if the disease shows no signs of yielding, twentyfour leeches are at once applied. During the course of the day the cold affusion is repeated at intervals of six hours, and if the bowels are not acted on the purgative is repeated. The result of this practice is.very striking, the mortality for the last three years till December, 1867, having been 1.1, or little more than 1 per cent.; and for the first seven months of the year 1868, the mortality has been nil. The Diagnosis of Anal Fistula.
Prof. H. R. Storer (Am. Journal of Obstetrics) objects to the following ways in the diagnosis of anal fistula :First, by filling the rectum with fluid, clear or colored, which is to be forced by muscular contraction downwards through the fistulous canal, and distending the inner opening; second, by injecting the fistula from its ontlet, and watching through the anal speculum for the emergence of the fluid at some paint within the rectal canal.
He regards both of them as unreliable, and both are difficult of performance. In injecting the fistula, a colored fluid is preferable to any other.
By everting the rectum from within the vagina, the difficulties are at once done away with. The rectal coat is exposed throughout its circumference; it is put upon the stretch and the rugous folds effaced; it is readily kept cleansed, and the smallest drop of fluid driven through the walls at any point, is compelled to reveal its source. By passing a hollow sound, like that of Savage, for applying liquids to isolated points of the mucous membrane lining the uterine cavity, or if the fistula be too contracted for this, by inserting as far within it as can be done, a perforated or grooved probe, and then applying to this a hypodermic syringe, the fluid can be driven directly into the inner opening, if it exist, or against the rectal wall at its nearest points and thus the diagnosis be effected, everything having been brought clearly within view by eversion. So far as he is aware, this method is a new one.
Malignant Disease of the Rectum.
Dr. Alden March, of Albany, New York, in a paper on “Scirrhus of the Rectum," read before the New York State VOL. IV.- NO. 9.
Medical Society, in 1868, gives the following results of his own observations on this disease: Contrary to the best authorities, malignant disease of the rectum and anus is most often found at the middle or somewhat advanced period of life. Most authors believe that women are most commonly its victims, but this does not accord with his observations, neither as relates to cancer nor to the more common affection of fistula in ano, having operated on the male for relief of the latter disease twice where he has once on the female.
The disease has developed in the apparently healthy as well as in the unhealthy, in the vigorous and robust as well as in the feeble, in the active as well as in persons of seden
In conclusion, he relates a case of scirrhus of the rectum, in a woman twenty-six years of age, which he removed with success. Stimulants, tonics, and anodynes were used freely ; the bowels remained unmoved from the Sth of January, the day of operation, till the 21st of January, some fourteen days. He believes that the ultimate success of the operation was due to the quiescent state of the bowels, till the union of the parts had become sufficiently firm to allow of a fæcal evacuation without danger of breaking up the union of the parts, as well as the general good management after the operation.-Med. Record.
Treatment of Syphilis of the Rectum.
M. Després, surgeon at Lorraine (Paris Cor. Med. and Surg. Reporter), has recently made a study of seven cases of phagedenic chancre of the rectum, and states that these rectal chancres are generally caused by direct contact of the pus which flows from chancres at the vagina, and which trickles down upon the anus. It penetrates by capillarity, in the same way as the pus of vaginitis, which causes an inflammation of the urinary meatus.
The treatment of these phagedenic ulcerations consists in cauterization, with a view of transforming the ulceration into a granulating surface analagous to that of a simple wound. M. Després passes over the chancre by means of pincers, meshes of lint imbued with a solution of chloride of zinc. This solution has the advantage of attacking with great energy, surfaces deprived of their epithelium, leaving the others intact. Large bougies of lint, covered with a pomade of lard
and glycerine, should be kept constantly in the rectum, and be renewed every twenty-four hours.
When ulceration and stricture co-exist, and pus flows from the anus, astringent injections should be used, made with eight grammes of rhatany, two to four grammes of dry chlorate of zinc, and two hundred and fifty grammes of water. On the same day two oil injections should be administered. Dilatation should then be sought by means of indiarubber canula.
Fistulæ of the rectum should be cauterized as well as the chancre, since they are equally phagedenic.--Ibid.
Insusceptibility of Pigeons to the Toxic Action of Opium.
S. Weir Mitchell, M. D., (Am. Jour. Med. Sciences,) finds from actual experiments that pigeons are proof against opium poisoning. He injected sulphate of morphia, afterwards forty drops of black-drop (acetum opi.,) and in ten minutes gave by the mouth, through a tube, fifty-five drops ; not a single sign of opium poisoning was detected.
Astounded at an immunity so perfect, he endeavored to discover what amount of opium was needed to cause death, and after various trials, the following final experiment seemed to him decisive; To a large pigeon, which, within the two preceding days, had swallowed forty-two drops of black drop, he gave, between two P. M. and six o'clock twenty-one grains of powdered opium in soft pills of three grains each. Except the usual tendency to remain quiet, none of the common evidences of opium poisoning appeared, and the pigeon was well and active the next day.
Sulphate of Suda and Ammonia in the Treatment of Inter
These remedies have been tested in a large number of cases of intermittent fever in the service of Prof. Austin, Flint, Bellevue Hospital. The following 'gave the conclusions arrived at:
1st, That in a few cases the paroxysms of intermittent fever are relieved and possibly arrested by the sulphate of soda or sulphate of ammonia.
2d, That in the large majority of cases these remedies fail entirely to arrest the paroxysms, or to arrest either their severity or frequency.
3d, That these remedies require to be given in large doses for a length of time in order to effect any appreciable improvement.
4th, That, when given in doses sufficient to modify or arrest the paroxysms, they produce considerable irritation of the stomach and internal canal.
5th, That as remedies for intermittent fever they are in every respect vastly inferior to quinine.
Svapnia and Sweet Quinine.-These preparations have been
recently introduced by FREDERICK STEARNS, of Detroit,
Mr. Stearns says: “Svapnia is a new and desirable form of opium, purified from all inert matter, such as vegetable fibre, etc., and with the thebaine, papaverine and narcotine of the drug removed entirely. It represents the anodyne and soporific properties of opium completely, whereas morphia is but one of them. The alkaloids morphia, narcia and codeia in this purified opium are in the combination existing naturally in the drug. It is made by assay; hence its uniformity is as great as that of morphia, a very great advantage over crude opium. It is solid and permanent, in scales like citrate of iron, and can be readily powdered or solved in cold water. Patients will bear the svapnia who can not tolerate opium or morphia. Its effects are more soothing and hipnotic than either. Those compelled to use opium, habitually, will find this much preferable to crude opium. Medium dose for an adult one grain in powder, pill or solution, and it does not constipate the bowels like opium itself.
The process for making the svapnia was first discovered by Dr. J. M. Bigelow, Surgeon U. S. Marine Hospital, Detroit.
Sweet Quinine.—“ The invention of Dr. Wm. Bullock, is a valuable discovery in pharmacy. It divests one of the most important of known reinedies of its greatest objections -its intense bitterness. Sweet quinine is as definite a chemical salt as the sulphate (or bitter) quinine, is made direct from the same source-Peruvian bark; has, like it, positive